Comparative Analysis of Early Versus Late Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreatography in Cases of Cholelithiasis with Choledocholithiasis

Abstract

Background: The optimal timing of laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis remains debated. While early LC (≤72 hours) may reduce operative difficulty and hospital stay, late LC (>6 weeks) has traditionally been practiced to allow inflammation to subside.

Methods: A prospective comparative study was conducted on 60 patients with cholelithiasis and choledocholithiasis who underwent successful ERCP for common bile duct clearance at a tertiary care hospital. Patients were randomized into early LC (within 72 hours; n=30) and late LC (>6 weeks; n=30) groups. Demographic, operative, and postoperative parameters including operative time, adhesion grading, conversion to open surgery, complications, and hospital stay were analyzed using standard statistical tests.

Results: Both groups were comparable in terms of age, sex, and comorbidities. Mean operative time was significantly shorter in the early LC group (56.2 ± 8.5 min vs. 77.4 ± 9.1 min; p<0.001). Severe adhesions were more frequent in late LC (40% vs. 10%; p=0.01). The mean length of hospital stay was reduced in the early LC group (2.9 ± 0.7 vs. 4.3 ± 1.2 days; p=0.002). Conversion to open surgery (1 vs. 2 cases) and postoperative complications (6.7% vs. 10%) were not statistically different.

Conclusions: Early LC within 72 hours of ERCP is safe and associated with shorter operative time, less operative difficulty, and reduced hospital stay without increasing complication rates. These findings support early cholecystectomy as the preferred strategy in patients with cholelithiasis and choledocholithiasis.